L'aménagement villageois sylvo-pastoral de la formation de brousse tachetée de Tientiergou (arrondissement de Say, Niger)

Le schéma directeur d'approvisionnement en bois de la ville de Niamey (SIDAN) a été établi en 1991. Il a servi de base aux textes réglementaires et fiscaux et au démarrage des actions de développement des premiers marchés ruraux et des aménagements forestiers. Le premier site choisi pour tester les aménagements forestiers a été celui de Tientiergou, dans l'arrondissement de Say à 50 km au Sud de Niamey. L'objectif visé était de mettre au point les techniques d'exploitation des formations arbustives à Combrétacées, caractéristiques des plateaux de la périphérie de la ville de Niamey. Ces modes d'exploitation devaient à la fois garantir une bonne préservation du milieu et donner aux populations rurales les moyens de les préserver, soit par des plantations ou des actions de DRS/CES, soit par une meilleure gestion agricole de leurs terres. Après avoir fait l'historique des aménagements forestiers au Niger, cet article présente le contexte physique et social du massif forestier de Tientiergou (30 000 ha), la situation agricole et pastorale, enfin l'inventaire des ressources ligneuses réalisé préalablement à l'aménagement. Les zones aménagement de type orienté (sans aménagements forestiers) ont un coût faible, qui varie de 1 270 FCFA/ha (pour un terroir de 3 500 ha) à 4 430 FCFA/ha (pour un terroir de 1 000 ha). Les aménagements forestiers (marchés ruraux contrôlés) entraînent une augmentation de plus de deux fois ce coût ( de 3 840 à 8 440 FCFA/ha). (Résumé d'auteur

Industrial symbiosis software: software and method to facilitate industrial symbiosis

Bedrijven gaan tegenwoordig vooral lineair om met hun materialen. Grondstoffen komen binnen, worden verwerkt tot producten en hun afval wordt afgevoerd. Binnen één bedrijf ziet dit er logisch uit, maar in een systeem van meerdere bedrijven is te zien dat dit efficiënter kan. Als het afval van een bedrijf gebruikt zou worden als grondstof door een ander bedrijf, ontstaat er industriële symbiose. Daardoor worden er minder grondstoffen verbruikt en worden bruikbare restmaterialen niet verspild. Om bedrijven te helpen bij het zoeken naar partners voor zulke uitwisselingen, is de software InduSym ontwikkeld. Met de software kunnen bedrijven hun grondstoffen en restmateriaal invoeren in een database. Een algoritme doorzoekt deze database en presenteert in een rapport de kansen om te komen tot een symbiotische uitwisseling van reststromen

Endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) for resection of large distal non-pedunculated colorectal adenomas (MATILDA-trial): Rationale and design of a multicenter randomized clinical trial

Background: Endoscopic mucosal resection (EMR) is currently the most used technique for resection of large distal colorectal polyps. However, in large lesions EMR can often only be performed in a piecemeal fashion resulting in relatively low radical (R0)-resection rates and high recurrence rates. Endoscopic submucosal dissection (ESD) is a newer procedure that is more difficult resulting in a longer procedural time, but is promising due to the high en-bloc resection rates and the very low recurrence rates. We aim to evaluate the (cost-)effectiveness of ESD against EMR on both short (i.e. 6 months) and long-term (i.e. 36 months). We hypothesize that in the short-run ESD is more time consuming resulting in higher healthcare costs, but is (cost-) effective on the long-term due to lower patients burden, a higher number of R0-resections and lower recurrence rates with less need for repeated procedures. Methods: This is a multicenter randomized clinical trial in patients with a non-pedunculated polyp larger than 20 mm in the rectum, sigmoid, or descending colon suspected to be an adenoma by means of endoscopic assessment. Primary endpoint is recurrence rate at follow-up colonoscopy at 6 months. Secondary endpoints are R0-resection rate, perceived burden and quality of life, healthcare resources utilization and costs, surgical referral rate, complication rate and recurrence rate at 36 months. Quality-adjusted-life-year (QALY) will be estimated taking an area under the curve approach and using EQ-5D-indexes. Healthcare costs will be calculated by multiplying used healthcare services with unit prices. The cost-effectiveness of ESD against EMR will be expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per recurrence free patient and as ICER showing additional costs per QALY. Discussion: If this trial confirms ESD to be favorable on the long-term, the burden of extra colonoscopies and repeated procedures can be prevented for future patients. Trial registration:NCT02657044(Clinicaltrials.gov), registered January 8, 2016

73 Industrial symbiosis software: software and method to facilitate industrial symbiosis

Bedrijven gaan tegenwoordig vooral lineair om met hun materialen. Grondstoffen komen binnen, worden verwerkt tot producten en hun afval wordt afgevoerd. Binnen één bedrijf ziet dit er logisch uit, maar in een systeem van meerdere bedrijven is te zien dat dit efficiënter kan. Als het afval van een bedrijf gebruikt zou worden als grondstof door een ander bedrijf, ontstaat er industriële symbiose. Daardoor worden er minder grondstoffen verbruikt en worden bruikbare restmaterialen niet verspild. Om bedrijven te helpen bij het zoeken naar partners voor zulke uitwisselingen, is de software InduSym ontwikkeld. Met de software kunnen bedrijven hun grondstoffen en restmateriaal invoeren in een database. Een algoritme doorzoekt deze database en presenteert in een rapport de kansen om te komen tot een symbiotische uitwisseling van reststromen

Diagnostic value of radiological staging and surveillance for T1 colorectal carcinomas: a multicenter cohort study

Background: The role of radiological staging and surveillance imaging is under debate for T1 colorectal cancer (CRC) as the risk of distant metastases is low and imaging may lead to the detection of incidental findings. Objective: The aim of this study was to evaluate the yield of radiological staging and surveillance imaging for T1 CRC. Methods: In this retrospective multicenter cohort study, all patients of 10 Dutch hospitals with histologically proven T1 CRC who underwent radiological staging in the period 2000-2014 were included. Clinical characteristics, pathological, endoscopic, surgical and imaging reports at baseline and during follow-up were recorded and analyzed. Patients were classified as high-risk T1 CRC if at least one of the histological risk factors (lymphovascular invasion, poor tumor differentiation, deep submucosal invasion or positive resection margins) was present and as low-risk when all risk factors were absent. Results: Of the 628 included patients, 3 (0.5%) had synchronous distant metastases, 13 (2.1%) malignant incidental findings and 129 (20.5%) benign incidental findings at baseline staging. Radiological surveillance was performed among 336 (53.5%) patients. The 5-year cumulative incidence of distant recurrence, malignant and benign incidental findings were 2.4% (95% confidence interval (CI): 1.1%-5.4%), 2.5% (95% CI: 0.6%-10.4%) and 18.3% (95% CI: 13.4%-24.7%), respectively. No distant metastatic events occurred among low-risk T1 CRC patients. Conclusion: The risk of synchronous distant metastases and distant recurrence in T1 CRC is low, while there is a substantial risk of detecting incidental findings. Radiological staging seems unnecessary prior to local excision of suspected T1 CRC and after local excision of low-risk T1 CRC. Radiological surveillance should not be performed in patients with low-risk T1 CRC.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Management of delayed bleeding after endoscopic mucosal resection of large colorectal polyps: a retrospective multi-center cohort study

Background and study aims  Delayed bleeding (DB) is the most frequent major adverse event after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs). Evidence-based guidelines for management of DB are lacking. We aimed to evaluate the clinical presentation, treatment and outcome of patients with DB and to determine factors associated with hemostatic therapy. Patients and methods  Patients with DB were identified by analyzing all consecutive EMR procedures for LNPCPs (≥ 2 cm) from one academic center (2012-2017) and seven regional hospitals (2015-2017). DB was defined as any postprocedural bleeding necessitating emergency department presentation, hospitalization or reintervention. Outcome of DB was assessed for three clinical scenarios: continued bleeding (CB), spontaneous resolution without recurrent bleeding during 24 hours observation (SR), and recurrent bleeding (RB). Variables associated with hemostatic therapy were analyzed using logistic regression. Results  DB occurred after 42/542 (7.7 %) EMR procedures and re-colonoscopy was performed in 30 patients (72 %). Re-colonoscopy and hemostatic therapy rates were 92 % and 75 % for CB (n = 24), 25 % and 8 % for SR (n = 12), and 83 % and 67 % for RB (n = 6), respectively. Frequent hematochezia (≥ hourly) was the only factor significantly associated with hemostatic therapy (RR 2.23, p = 0.01). Re-bleeding after endoscopic hemostatic therapy occurred in 3/22 (13.6 %) patients. Conclusion  Ongoing or recurrent hematochezia is associated with a high rate of hemostatic therapy, warranting re-colonoscopy in these patients. A conservative approach is justified when bleeding spontaneously settles, and without recurrent hematochezia during 24 hours observation patients can be safely discharged without endoscopic re-examination

Periprocedural adverse events after endoscopic resection of T1 colorectal carcinomas

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome

Cellular mechanisms in basic and clinical gastroenterology and hepatolog